Removing unwanted appendages

The incoherence of post-modern medicine

The below article - as do so many things these days - got me thinking about how far we are down an extremely strange rabbit hole. Would someone who has been in a coma since 2015 (let alone 2000, or 1950) believe that these headlines were real?

Yes, this really happened in Canada.

Body integrity identity disorder is a VERY interesting and bizarre condition. It’s been known for many decades. A person with BIID comes to believe that they are “meant” to be an amputee. Or blind. Or deaf. Or wheelchair-bound. Some resort to chopping off their own limbs or digits. They believe they were “born in the wrong body”. Sound familiar?

In fact, some very smart psychiatrist authors have written fictional pieces about this (that headline award-winning books of short stories - well worth buying, in my extremely biased opinion)

We should not be shocked that there are now finger-choppers

But back to the 3-fingered fellow who stimulated this Substack. What kind of surgeon would amputate someone’s perfectly good fingers? A post-modern one, that’s who.

Agreeing to remove perfectly good fingers is just a short step or two down the same path we have already been travelling. A path of post-modern medical decision-making.

In Modern Medicine, The Customer is Always Right

In modern gender ideology, for instance, the customer is always right. “A child knows” his or her gender, we are told. Anyone who would dare question the belief is a hateful transphobe, endangering the patient. In fact, it is so dangerous to question a patient’s belief about his or her gender that we have passed legislation in Canada to make doing so illegal. The idea that a person should be “free” to choose his gender, and demand that others treat him as a boy/girl/woman/non-binary/whatever, is so universally accepted that even almost half of the Conservatives voted for Bill C-6.

As a logical extension (pun intended) of gender self-definition, patients now have the right to demand that their body parts be rearranged to suit their feelings about their body. If you have a vagina but want a penis (or vice-versa), you have the right to one. If you have breasts and don’t want them (or don’t and do), someone must operate on you.

Our new approach to euthanasia also stems from this same “who am I to question the patient” idea. Sure, your patient might be 32 and physically healthy. But if he says his depression is unbearable, and that he wants to die, who are you to question his internal experience? Feeling that the best approach is to help him resolve his issues and keep living, instead of being complicit in his suicide, is simply proof that you are patriarchal and do not respect his autonomy.

Traditionally we were all part of families, churches, communities, and nations, connected by our traditions and shared beliefs. We could ponder the struggles of another, using our learned values and norms to consider the best way to help him. For instance, if an alcoholic cousin had lost his job (again) and hit you up for some money, you could take into consideration that the last time you did so, he used it to buy more booze and ended up in hospital. You could offer to drive him to the detox unit instead.

We used to believe that an individual human being can go astray. When he wandered outside of guardrails, it was reasonable to try to pull him back onto the path. If drug addiction was ruining his life, we could tell him that he should stop. If he wanted to cut his arm off, we could tell him that was a bad idea. The liberalism that came with the enlightenment greatly widened guardrails. Post-modernism told us that any guardrails are evil and must be destroyed at any and all costs.

And thus post-modern society has become solipsistic. We abandoned the guardrails that came with a higher power, spiritual ties, cultural expectations and adherence to norms. And here in Year Zero, in the absence of accepted standards, “You should do as God wills” has changed to “Do what thou wilt”. Solipsism is the idea that each individual is a disconnected entity with a completely unique and separated consciousness. How then can we ever judge anyone else? And since we can’t, the only thing we can do to help a struggling human is to cater to his whims. (As a great antidote to this oops-my-brain-fell-out type of empathy, I highly recommend Paul Bloom’s excellent book.)

Is “Autonomy” the same as “you have to do whatever I tell you”?

Solipsism, and the inevitable abandonment of judgment that comes with it, has allowed us to evolve a society where VANDU (The Vancouver Area Network of Drug Users) is now a “stakeholder” when making decisions about drug policy (including law enforcement, “safe supply” and more). A society where WPATH (the World Professional Association on Transgender Health - an activist group) were so quickly accepted as “the experts” on how to approach and treat gender dysphoria. A society where “pain experts” easily convinced a whole generation of doctors to prescribe “non-addictive” oxycontin wantonly. Pain is pain if the patient says so. Your job is to prescribe, not to question.

If our guiding principle is complete patient autonomy without judgment, who are you to say that your young depressed patient shouldn’t be euthanized? That your 16 year old girl with ROGD (Rapid Onset Gender Dysphoria - ie: she suddenly says she is a boy) shouldn’t have multiple surgeries? That Frank shouldn’t get a big dose of daily drugs funded by the taxpayer?

Public Healthcare is a Zero-Sum game

It seems like a flippant aside, but we should also keep in mind that every harmful procedure done means money and time diverted from real healthcare. When a physician spends her time euthanizing over 400 patients, she is not helping look after those whose goal is to survive. Wait lists for euthanasia in Canada are very often shorter than for cancer care or palliative care.

When a surgeon takes a precious OR time slot to remove healthy fingers from a mentally disturbed patient, someone waits longer for her tendon repair. When we agree to fund removal (or addition) of breasts for “non-binary” people who feel they were born with the wrong body parts, we consume a surgical time slot where someone could have had her lumpectomy. Here in Nova Scotia, I can currently get a 13-year-old patient with a mental health disorder “assessed” (and by assessed, I mean “affirmed” and started on puberty blockers) for her feelings of gender dysphoria within a few days, but if she has the misfortune of simply being depressed and a bit suicidal, she could wait months to see a psychiatrist.

And with socialized medicine, not only does the patient have a right to whatever procedure he wants, but you have the responsibility to pay for it.

How far might this go?

Where does this all end? Will the below litigant be granted his “right” to get a vagina added to complement his penis, paid for by the largesse of the Canadian taxpayer? What if he feels he should have been born with two penises and one vagina? Who are we to say no? Shouldn’t we respect the patient’s wishes? Couldn’t he actually be a hermaphrodite wrongly born into a man’s body?

We are a long way down a rabbit hole which in many ways is stranger than Alice’s Wonderland. In Wonderland, they still knew the difference between male and female, and nobody asked to have good fingers chopped off and was told “sure, that sounds reasonable!”. Off with his head, but not with his fingers in Wonderland. The Red Queen was a more reasonable ruler than Justin Trudeau in many ways.

In a world where we rely on “lived experience” as an infallible guide, where toddlers can “know their gender”, where we are told that a white person could never possibly understand the experience of a person of a different skin tone, my guess is that our above protagonist will succeed in his quest to become a hermaphrodite. Because we can’t draw lines. Doing so requires judgment. And in the judgment of many, the worst thing to be is judgmental. Make no mistake, if you judge, the non-judgmental will judge you harshly.

"These days, one sometimes hears people praise themselves for being non-judgmental, but this is a misuse of language. What they mean is that they are not, or at least do not consider themselves to be, censorious, that is to say the kind of person who makes quick and damning judgments on others (actually, they are very likely to be censorious towards those whom they consider censorious). They cannot possibly mean that they do not make judgments, because the supposed desirability of not making judgments is itself a judgment."  Theodore Dalrymple, Ecclesiastes and The Theatre of the Absurd

Any virtue becomes a vice if it is not balanced with its counterpart. Confidence is wonderful, but not without humility. Courage is great, but becomes deadly if not balanced with appropriate caution. Self-control is healthy, but so is some spontaneity.

It seems to me that until we relearn the ancient wisdom that reflexive empathy must always be balanced with deliberation and judgment, we will inevitably continue further and further down this strange finger-amputating rabbit hole. It’s great to be open-minded, but not so much that your brain falls out.